Applicant’s Name in Full:

Date of Birth:

Status of applicant: Sole Trader Partnership. Pty. Ltd.

Trading Name: (If different from above)

ACN: (If Applicable)

ABN: (If Applicable)

Business Address:

Home Address:

Email Address:

Telephone No:          Mobile No: (Optional)

Fax No: (Optional)

Choose One:

Employed

Current Employer :      Position:

Self-Employed      

Business type:      Length of time:

Directors/Partners (Company, Trust and Partnership applicants only)

Name:

D.O.B:

Private Address:

Extra:

Name:

D.O.B:

Private Address:

Yes or No

• Is there any current or has there been prior investigations into yourself and/ or your business entity(s) by the Department of Consumer Affairs, Australian Securities and Investment Commission, Police Dept. or any other government agency(s).

                  Yes No

• Have you ever been accredited by a lender(s) as a mortgage broker/consultant either directly or via another mortgage broker/originator/aggregator company?

                  Yes No

               If Yes, please list below and indicate if accreditation still current:

• For existing mortgage consultant-applicants only: Please state the likely volume of business that will be referred monthly on average.

               Monthly estimated applications:

               Monthly estimated revenue: $

               Annual referred application:

               Annual estimated settlement: $

Conditions to be fulfilled:

• Acceptance of Alliance Partner Mortgage Introducer Deed.
• 100 point identification verification;
• Credit Check.
• National Police Check.
• Professional Indemnity Insurance Cover (minimum $1 million per transaction).
• Membership (AMC status) with the Mortgage & Finanace Association of Australia (MIAA).

I/We warrant that the information disclosed herein is true and correct. By submiting this application form, I acknowledge that I have read and accept the company's privacy statement.

Name:

Signature:

Date:

Extra: (Optional)

Name:

Signature:

Date: